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Oncology > Exam 3 > Flashcards

Exam 3 Flashcards

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1
Q

Corrected Calcium calculation

A

Corrected Ca = Measured Ca + 0.8*(4 - serum albumin)

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2
Q

HCM management

A
  1. Hydration
  2. Diuresis with furosemide
  3. Bisphosphonates: zoledronic acid > pamidronate
  4. Adjunctive: calcitonin, denosumab
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3
Q

ANC calculation

A

ANC = (% segmented + % bands) * WBC/100

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4
Q

What is febrile neutropenia?

A
  1. Severe neutropenia ANC <500
  2. Fever (101+ F)
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5
Q

FN low risk criteria

A
  1. MASCC 21+, CISNE <3
  2. Outpatient when having fever
  3. No comorbid illness requiring hospitalization
  4. Short duration <7 days
  5. Good performance score ECOG 0-1
  6. No hepatic or renal insufficiency
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6
Q

FN high risk criteria

A
  1. MASCC <21, CISNE 3+
  2. Inpatient when having fever
  3. Comorbid illness or clinically unstable
  4. Prolonged duration 7+ days
  5. uncontrolled/progressive cancer
  6. Hepatic or renal insufficiency
  7. pneumonia or other infections
  8. HSCT or hematologic malignancy
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7
Q

FN high risk empiric therapy

A
  • Pip/tazo, cefepime, meropenem, imipenem/cilastatin
  • Carbapenems if ESBL
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8
Q

FN low risk empiric therapy

A
  • Cipro + amoxicillin/clavulanate
  • Cipro + clindamycin, levofloxacin, moxifloxacin
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9
Q

FN Vanco addition

A
  1. MRSA or PCN-resistant
  2. Skin and soft tissue infection
  3. Pneumonia
  4. IV catheter-related infection
  5. Gram+ culture
  6. Clinical instability: HoTN, shock
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10
Q

TLS complications

A
  • Hyper: phosphatemia, kalemia, uricemia
  • Hypocalcemia
  • AKI
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11
Q

TLS uric acid abnormality

A

> 8.0 mg/dL

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12
Q

TLS phosphate abnormality

A

> 4.5 in adults, >6.5 in children

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13
Q

TLS potassium abnormality

A

> 6.0 mg/dl

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14
Q

TLS calcium abnormality

A

Corrected calcium <7.0 mg/dl or measured calcium <1.12

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15
Q

TLS low risk management

A

IV fluids, allopurinol, daily labs

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16
Q

TLS intermediate risk management

A

IV fluids, allopurinol, labs Q8-12H

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17
Q

TLS high risk management

A

IV fluids, rasburicase, labs Q6-8H, cardiac monitoring

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18
Q

TLS established management

A

IV fluids, rasburicase, labs Q4-6H, cardiac monitoring

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19
Q

TLS fluids backbone

A

crystalloids

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20
Q

TLS hyperkalemia backbone

A
  • Stabilize myocardium: calcium gluconate/chloride
  • Intracellular shift of K: regular human insulin, sodium bicarb, albuterol
  • Elimination of K: loop diuretics, sodium polystyrene, sulfonate, hemodialysis
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21
Q

TLS hyperphosphatemia backbone

A

Calcium carbonate/acetate, Sevelamer, Lanthanum

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22
Q

TLS hypocalcemia backbone

A

Treat if symptomatic with IV Ca2+

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23
Q

TLS hyperuricemia backbone

A
  • Allopurinol
  • Rasburicase: high UA >7.5
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24
Q

Breast cancer risk factors (12)

A
  1. Female
  2. > 65 yrs
  3. non-Hispanic whites & blacks
  4. Higher endo/exogenous estrogen exposure
  5. Genetic mutations: BRCA1/2, TP53, PTEN
  6. FH of breast & ovarian cancer
  7. Personal hx of BC
  8. DCIS, LCIS
  9. Benign breast disease
  10. Breast density
  11. Prior thoracic irradiation 10-30 yrs
  12. Environment/lifestyle
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25
BC risk factor: higher endogenous estrogen exposure
1. Early menarche <11 yrs 2. Older age at birth of first child (>30 yrs) or nulliparity 3. Later menopause >55 yrs
26
BC risk factor: higher exogenous estrogen exposure
1. Risk of postmenopausal estrogen replacement therapy & OC controversial - OC: benefits far outweigh the small increased risk of developing BC
27
BC when to use Gail model
>35 yrs with a family history
28
BC when NOT to use Gail model
1. Predisposing genetic mutation 2. Hx of thoracic radiation 3. Prior hx of BC
29
BC NCCN screening recommendation
40+ yrs annual mammogram with tomosynthesis
30
BC ACS screening recommendation
- 40-44 optional annual mammogram - 45-55 annual mammograms - 55+: mammograms every 1,2 yrs
31
BC USPSTF screening recommendation
- 40-49: optional mammograms every 2 yrs - 50-74: mammograms every 2 yrs
32
BC chemoprevention agents
Tamoxifen, raloxifene, anastrozole, exemestane
33
BC: node-, HER2+, ER/PR+
- <0.5cm: none - 0.6-1 cm: endocrine - >1cm: endocrine + chemo + trastuzumab
34
BC: node-, HER2+, ER/PR-
- <1cm: none - >1cm: chemo + trastuzumab
35
BC: node-, HER2-, ER/PR+
- <0.5cm: none - 0.6-1cm: Oncotype DX RS <26 = endo, RS 26+ = endo + chemo - >1cm: same as above
36
BC: node-, HER2-, ER/PR-
- <1cm: none - >1cm: chemo
37
BC: node+, ER/PR+
- Endo + chemo - If HER2+: trastuzumab + pertuzumab
38
BC: node+, ER/PR-
- Chemo - If HER2+: trastuzumab + pertuzumab
39
BC Stages I-III, HER2-
1. **Dose-dense AC -> T** = doxorubicin (Adriamycin) and Cyclophosphamide + Paclitaxel 2. TC = docetaxel (Taxotere) and Cyclophosphamide
40
BC anthracyclines toxicities, monitor
- Cardiotoxicity - Echocardiogram or MUGA
41
BC Stages I-III, HER2+
1. **TCH +/- pertuzumab** = Docetaxel (Taxotere), Carboplatin, Trastuzumab (Herceptin) +/- pertuzumab 2. Paclitaxel + trastuzumab --> reserved for low risk, not eligible for other regimens
42
BC HER2i toxicities, monitor
- Cardiotoxicity - ECHO or MUGA
43
BC adjuvant endocrine therapy for premenopausal
Tamoxifen
44
BC adjuvant endocrine therapy for postmenopausal
- TAM - AI (preferred): Anastrozole, Letrozole, Exemestane
45
BC Stage IV, ER/PR+, HER2-
- AI + CDK4/6i - Fulvestrant + CDK4/6i
46
BC Stage IV, ER/PR+, HER2-, visceral crisis or endocrine refractory - BRCA mutation vs no
- BRCA1/2: PARPi (olaparib, talazoparib) - No: single chemo
47
BC Stage IV, ER/PR+, HER2+
1. AI +/- trastuzumab or lapatinib or both 2. Fulvestrant +/- trastuzumab 3. TAM +/- trastuzumab
48
BC Stage IV, ER/PR-, HER2+
Pertuzumab + trastuzumab + docetaxel (preferred) or paclitaxel
49
BC Stage IV ER/PR-, HER2- (TNBC): - PDL1+ vs -
- PDL1+: pembrolizumab + carboplatin + paclitaxel/albumin-bound/ gemcitabine - PDL1-: BRCA1/2 = PARPi or platinums vs no mutation = single chemo
50
NHL: DLBCL stages I-II
**R-CHOP** Rituximab, Cyclophosphamide, Doxorubicin (Hydroxydaunomycin), Vincristine (Oncovin), Prednisone
51
NHL: DLBCL stages III-IV
**R-CHOP** or **Pola-RCHP** Polatuzumab vedotin, Rituximab, Cyclophosphamide, Doxorubicin (Hydroxydaunomycin), Prednisone
52
NHL: vincristine toxicity
Neurotoxicity, constipation
53
NHL: Polatuzumab vedotin: target, cytotoxic payload, toxicities, premed
1. CD79b 2. MMAE 3. Peripheral neuropathy 4. Antihistamine, antipyretic
54
HL: Stages I-II cHL treatment
**ABVD** Doxorubicin (Adriamycin), Bleomycin, Vinblastine, Dacarbazine
55
HL: Stages III-IV cHL treatment
**ABVD** or **AAVD** Doxorubicin (Adriamycin), Brentuximab vedotin (Adcetris), Vinblastine, Dacarbazine
56
HL: bleomycin vs brentuximab vedotin toxicity
- Bleo: pulmonary toxicity (fibrosis) - B.v: peripheral neuropathy
57
CML chronic phase blast count
<10%
58
CML accelerated phse blast count
10-19%
59
CML blast crisis blast count
>20%
60
CML chronic phase initial treatment
1st/2nd gen TKIs: imatinib, dasatinib, nilotinib, bosutinib
60
CML accelerated phase initial treatment
2nd/3rd gen TKIs: dasatinib, nilotinib, bosutinib, ponatinib
61
CML 1st gen TKI toxicity
- Imatinib: fluid retention (periorbital edema)
62
CML 2nd gen TKI toxicity
- Dasatinib: fluid retention (pleural or pericardial effusions) - Nilotinib: QTc prolongation & sudden death --> monitor electrocardiogram (ECG) - Bosutinib: diarrhea
63
CML 3rd gen TKI indication, toxicity
- Ponatinib: T315I+, arterial occlusion, VTE, HF, hepatotoxicity - Ascminib: STAMPi, 3rd line, T315I+; pancreatitis, HTN, hypersensitivity, muscle pain
64
AML WHO 2016 classification
1. 20+% blast count 2. Cytogenic mutations even with <20%: t(8;21), t(16;16), inv(16)
65
AML favorable risk
t(8;21), t(16;16), inv(16)
66
AML poor risk
Complex (3+ chromosomal abnormalities) or monosomal karyotype, -5,del(5q),-7, TP53
67
AML Cytarabine toxicities, supportive care, monitoring
- High dose (1000+ mg/m2): neurotoxicity, ocular / NV - Prophylactic steroid eye drops (high dose), antiemetics - Cerebellar function before each dose (high dose)
68
AML gemtuzumab ozogamicin: target, cytotoxic payload, toxicities, premed
- CD33 - Calicheamicin derivative - Hepatotoxicity (veno-occlusive), infusion rxn - Corticosteroid, antipyretic, antihistamine
69
AML favorable risk induction, postremission: CD33-
1. **7+3** = Cytarabine 7 days, Daunorubicin or Idarubicin 3 days 2. **HiDAC** = High-dose Ara-C = Cytarabine on days 1, 3, 5
70
AML favorable risk induction, postremission: CD33+
1. **7+3 + Gemtuzumab ozogamicin (GO)** = Cytarabine 7 days, Daunorubicin or Idarubicin 3 days, GO on days 1, 4, 7 2. **HiDAC + GO** = High-dose Ara-C = Cytarabine on days 1, 3, 5, GO on day 1 of first 2 cycles
71
AML Midostaurin: class, indication, toxicities
- 1st gen, type 1 FLT3i - FLT3+ ITD & TKD - N/V
72
AML Quizartinib: class, indication, toxicities
- 2nd gen, type 2 FLT3i - FLT3 ITD+ - QTc prolongation --> monitor electrocardiograms (ECGs) [REMS]
73
AML FLT3-TKD induction, postremission
1. 7+3 + midostaurin 2. HiDAC + midostaurin
74
AML FLT3-ITD induction, postremission
1. 7+3 + midostaurin OR quizartinib 2. HiDAC + midostaurin OR quizartinib 3. Hematopoietic stem cell transplant ASAP
75
AML Liposomal Daunorubicin-Cytarabine (CPX-351): indication, toxicities, monitor, clinical pearls
- Therapy-related AML - Cardiotoxicity - ECHO/MUGA - Longer time to recover bone marrow, no alopecia
76
AML hypomethylating agents (HMA): agents, toxicities, onset
- Azacitidine, Decitabine - Myelosuppression - Slow onset
77
AML Venetoclax (VEN): dose reduction needed when, toxicities
- Moderate or strong CYP3A4 inhibitor - Bone marrow suppression
78
AML IDH inhibitors: agents, toxicities
- Ivosidenib (IDH1), Enasidenib (IDH2) - Differentiation syndrome
79
AML low intensity w/o mutation
VEN + HMA
80
AML low intensity IDH1 mutation
- VEN + HMA - Ivosidenib + azacitidine - Ivosidenib
81
AML low intensity IDH2 mutation
- VEN + HMA - Enasidenib
82
AML low intensity FLT3 mutation
VEN + HMA
83
ALL cytogenetic poor risk
- TP53 mutation - Complex karyotype (5+ chromosomal abnormalities) - t(9;22) - Hypodiploidy (<44 chromosomes) - Ph-like ALL
84
ALL philadelphia chromosome breakpoints in BCR gene in CML vs ALL
- CML: p210 - ALL: p190
85
ALL induction therapy backbone
**Vincristine + Corticosteroids** (dexamethasone OR prednisone) **+ Anthracyclines** (Daunorubicin OR doxorubicin)
86
ALL consolidation therapy
High-dose MTX, cytarabine, 6-mercaptopurine, pegaspargase
87
ALL maintenance therapy
Weekly MTX, periodic vincristine + corticosteroids, daily 6-mercaptopurine
88
ALL **Hyper CVAD**
- A cycle: Hyperfractionated Cyclophosphamide (+mesna) + Vincristine + doxorubicin (Adriamycin) + Dexamethasone - B cycle: High dose MTX + high dose cytarabine
89
ALL relapsed/refractory Ph-
- Blinatumomab - Inotuzumab ozogamicin - Brexucabtagene autoleucel, tisagenlecleucel (<25 yrs or 2+ relapses)
90
ALL relapsed/refractory Ph+
- TKI +/- chemo or corticosteroid - Blinatumomab or inotuzumab ozogamicin +/- TKI - Brexucabtagene autoleucel monotherapy - Tisagenlecleucel (<25 yrs or 2+ relapses and failure of 2 TKIs)
91
ALL BiTE binds to which CD__ on B-cells & T-cells?
- CD19 on B - CD3 on T
92
PedM Childhood vs adult cancer
1. Rarely genetically linked or attributed to lifestyle/ environmental factors 2. Types of cancer that are prevalent 3. Higher survival rates 4. Treatment often more “intense” with curative agent 5. Larger concern for long-term effects of cancer tx 6. Less well-established tx regimens
93
PedM B-cell ALL standard risk
1-10 yrs, <50,000 WBC
94
PedM B-cell ALL high risk
<1 yr or >10 yrs, >50,000+ WBC
95
PedM B-cell ALL standard risk induction
**3 drug induction** Dexamethasone, vincristine, asparaginase
96
PedM B-cell ALL high risk induction
**4 drug induction** Dexamethasone (>10 yrs Prednisone), vincristine, asparaginase, daunorubicin
97
PedM AML Induction I vs II
- I: **DA10 + GO** = cytarabine 10 days, daunorubicin days 1, 3, 5 + gemtuzumab ozogamicin - II: **DA8** = cytarabine 8 days + daunorubicin days 1, 3, 5
98
PedM Neuroblastoma staging by tumor location: I, II, III, IV, IV-S
I: confined to area of origin and completely resected II: localized III: tumor crosses midline or positive contralateral lymph nodes IV: distant metastasis IV-S: metastasis confined to skin, liver, BM in <1 yrs
99
PedM Neuroblastoma intermediate risk
- <18 yrs - **Hyperploidy** - Stage I, II - Stage III non MYCN amplified - Stage IV-S non MYCN amplified
100
PedM Neuroblastoma high risk
- **>18mo** - **Hypodiploidy** - Stage III MYCN amplified - Stage IV and IV-S MYCN amplified - **MYCN amplification**
101
PedM Neuroblastoma high risk induction chemo
Cisplatin, etoposide, vincristine, doxorubicin
102
PedM Dinutuximab premedication
1. IV hydration 2. Antihistamine 3. Antipyretic: APAP 4. Analgesics: morphine 5. Antiemetics
103
PedM Osteosarcoma arise from ___, treatment
- Immature spindle cells - **MAP** = High dose MTX, Doxorubicin, Cisplatin
104
PedM Ewing Sarcoma arise from ___, molecular genetics
- Neuroectodermal cell - Reciprocal translocations on chromosome 22q12 = **EWSR1** gene
105
PedM Ewing Sarcoma treatment
- **Radiation** - **VDC/IE** = Vincristine, doxorubicin, cyclophosphamide / ifosfamide, etoposide
106
PedM anthracycline associated with ___ toxicity
Cardio
107
PedM secondary malignancies associated with which chemo?
Alkylating agents, Etoposide
108
PedM neuro-cognitive effects are associated with ___ (3)
1. Craniospinal radiation 2. High-dose cytarabine 3. Occupational, vocational therapy
109
PedM infertility associated with ___
- Alkylating agents: carboplatin, cisplatin - Radiation to abdomen/pelvis
110
PedM pulmonary fibrosis associated with ___, screening, lifetime max dose
- Bleomycin - Yearly pulmonary function test - 400 units
111
PedM ototoxicity is associated with ___, screening
- Platinum agents: **cisplatin** > carbo - Audiometry testing
112
SCD HbSS
Sickle cell disease
113
SCD HbSC
- More "mild" - 1 gene for hemoglobin S, one for another abnormal HbC
114
SCD HbSA
- Sickle cell trait - 1 for hemoglobin S, 1 for hemoglobin A - X manifestations but can pass along S gene
115
SCD HbS beta-thalassemia
1 for hemoglobin S and 1 for beta-thalassemia
116
SCD complications
1. Vaso-occlusive crisis 2. Splenic sequestration 3. Acute chest syndrome 4. Priapism 5. Pneumococcal infection 6. Cerebral infarction 7. End-organ damage
117
SCD Vaso-occlusive crisis: what it is, treatment
- Sudden severe pain - Dactylitis: swelling of hands and feet - **NSAID + APAP + Opioid** , fluids, ketorolac (IV NSAID)
118
SCD Streptococcus pneumoniae vaccine
1. 15-valent (PCV15) or 20-valent (PCV20) - 4 doses given at 2, 4, 6, mo and 12-15 mo 2. 23-valent (PPSV23) - Age 2-5 if given at least 1 dose of PCV20 --> X - Age 2-5 if no PCV20 given --> 1 dose of PCV20 or PPSV23 at least 8 weeks after the most recent PCV - If PPSV23 given, 1 dose of PCV20 or second PPSV23 dose at least 5 yrs later
119
SCD Pneumococcal infection prevention: Antimicrobial prophylaxis
PCN V Potassium (PenVK) - Infants, <3 yrs: 125 mg BID - >3+ yrs: 250 mg BID
120
SCD Meningococcal vaccine
1. Menveo - Dose 1 at 8 wks: 4-dose series 2, 4, 6, 12 mo - Dose 1 at 7-23 mo: 2-dose series (dose 2 at least 12 wks after dose 1 and after the 1st bday) - Dose 1 at 24 mo or older: 2-dose series at least 8 wks apart 2. MenQuadFi - 24 mo or older: 2 doses at least 8 wks apart
121
SCD Acute chest syndrome: treatment
- 3rd gen cephalosporins (Ceftriaxone) + Macrolide (Azithromycin) - Oxygen supplementation if hypoxic - Pain management: NSAID + APAP +/- Opioid - IV hydration
122
SCD Hydroxyurea: MoA, treatment increases production of ___, AEs
- Ribonucleoside diphosphate reductase inhibitor - Fetal hemoglobin - Myelosuppression

Oncology (4 decks)

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